Provider Demographics
NPI:1295438083
Name:FORD, RANDALL CHAPTMAN
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:CHAPTMAN
Last Name:FORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 S PRESTON RD STE 116241
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-3885
Mailing Address - Country:US
Mailing Address - Phone:469-305-2871
Mailing Address - Fax:
Practice Address - Street 1:3900 S STONEBRIDGE DR STE 604
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-8051
Practice Address - Country:US
Practice Address - Phone:469-946-8255
Practice Address - Fax:972-546-7914
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86723101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional